Provider Demographics
NPI:1760239586
Name:DECESARE, KALYN (RDN, LD)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:DECESARE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3231
Mailing Address - Country:US
Mailing Address - Phone:270-991-2405
Mailing Address - Fax:
Practice Address - Street 1:1208 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3231
Practice Address - Country:US
Practice Address - Phone:270-991-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86345261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered